Moving From Offers to Solutions

Size: px
Start display at page:

Download "Moving From Offers to Solutions"

Transcription

1 Moving From Offers to Solutions ALIGN CHANNEL STRATEGIES WITH PATIENT NEEDS TO REDUCE ACCESS BARRIERS Doug Gabbard The views and opinions expressed and presented here are my own and do not reflect the views and opinions of AstraZeneca

2 Everything should be made as simple as possible, but not simpler. The simplest explanation with edits from Legal

3 Agenda Historical Perspective Todays Challenges Improving Affordable Access Program Design and Channel Mix

4 How did these get started Where did it begin? 1987 Prescription Drug Marketing Act placed restrictions on product samples This created the need for an easier way to enable product trial for patients Vouchers were born to perform as samples Savings cards created ongoing savings beyond first use Where do they fit in today? Restricted formulary access High deductible health plans Non-sampling clinics

5 The Vicious Circle 1. Rising healthcare costs are increasing medication copays 2. Higher copays shown to reduce medication adherence rates 3. Low medication adherence associated with poor disease control 4. Poor disease control negatively impacts patient health outcomes 5. Poor health outcomes increases healthcare costs

6 What does the data say? Recent report published by CVS Health Research Institute says The results of this systematic review of past studies suggests that restricting the availability of prescription drugs or prohibiting access could have collateral negative effects on patients' health and may not produce the expected cost-savings Study findings related to use of enhanced/expanded drug insurance programs: 1. More patients were able to afford important medications and were more adherent 2. Decreased costly complications and overall health care use, including hospitalizations 3. Several studies also showed a negative impact on patient health outcomes when insurers placed burdensome caps on drug benefits 4. Authors observed a consistent link between drug insurance and improved patient health status. Source: American Journal of Public Health, Brigham and Women's Hospital and the CVS Health Research Institute

7 What does the data say? Report published by CVS Health Research Institute says cost is the strongest predictor of abandonment The data shows abandonment rates: 1.4% for co-pays of $10 or less 3.4% for co-pays between $30 and $40 4.7% for co-pays of $50 patients having a co-pay of $50 almost four times more likely to abandon a prescription at a pharmacy than those paying $10 Source: Annals of Internal Medicine, Harvard, Brigham and Women's Hospital and the CVS Health Research Institute

8 Patient Cost Sensitivity Physician Perspective RHEUMATOID ARTHRITIS Survey collected: 08/2014 to 09/2014 Physicians are indicating that patients are bringing up the affordability of their medication. 60% of physicians first look to co-pay programs when their patients indicate they cannot afford meds. PATIENTS INDICATING NON-AFFORDABILITY FOR THEIR CURRENT MEDICATIONS - FREQUENCY Never (1) Sometimes (2,3) Very often (4,5) n = 144 physicians 58% 42% WHAT DO YOU DO NEXT? Search for savings such as co-pay programs 60% Refer them to your case manager 17% Switch them to a cheaper therapy 12% Tell your patients that assistance is available; they just need to search the internet 7% Keep them on the medication (drug is very important) Other 1% 2% Q: How frequently do patients indicate they cannot afford their current medications? Source: Zitter Health Insights: Co-Pay Offset Monitor, Feb 2015 Q: When patients indicate they cannot afford their medication, do you typically: (options listed in chart)

9 Cost and Primary Stakeholder Behavior DIABETES Survey collected: 12/2014 to 1/ % of surveyed physicians report of switching the drug to a cheaper therapy when patients indicate non-affordability. Pharmacists report to try more for searching savings offer than physicians. WHEN PATIENTS INDICATE THEY CANNOT AFFORD THEIR MEDICATION, WHAT DO YOU DO NEXT? Physicians Pharmacists Switch them to a different cheaper therapy 47% Switch them to a different cheaper therapy 25% Search for savings such as co-pay offset programs 32% Search for savings such as co-pay offset programs 54% Refer them to your case manager 7% Tell your patients that assistance is available, they just need to search the internet 7% Tell your patients that assistance is available, they just need to search the internet 21% Other 4% Keep them on the medication (drug is very important) 4% N = 108 physicians Other 2% N = 61 pharmacists Source: Zitter Health Insights: Co-Pay Offset Monitor, Feb 2015 Emerging category in a highly competitive therapeutic area

10 Cost sensitivity DIABETES Survey collected: 12/2014 to 1/2015 Patients report that they will stop filling their prescriptions once their co-pay hits around $85. HOW MUCH IS YOUR CO-PAY FOR: $90 Patients Generic drug co-pay Branded drug co-pay $80 $70 $60 $50 $40 Average co-pay at which patients report to start looking for savings = $ (n = 209 patients) Average co-pay at which patients report to stop filling prescriptions = $ (n = 209 patients) $30 $20 $10 $- $41 $44 $12 $12 $12 $11 Therapeutic area average (n = 209) Category average X (n = 119) $39 Category average Y (n = 51) $44 Category average Z (n = 75) Source: Zitter Health Insights: Co-Pay Offset Monitor, Feb 2015

11 Population Mix Diabetes Study Diabetes O V E R A L L P O P U L AT I O N M I X A L L P R E S C R I P T I O N S v s. P R E S C R I P T I O N S W I T H C O - PAY C A R D All Prescriptions (n=2,056,247) Rxs with co-pay card (n=161,202) 84% 55% 39% 4% 7% 3% 2% 7% Paid by Cash (n=72,493/10,634) Commercially Insured (n=1,135,893/135,537) January 2014 June 2014 Government Insured * (n=799,748/4,232) Other (n=48,116/10,799) Patients were enrolled in a 6-month ( January 1, 2-14 to June ) cohort and were followed for 6 months. Co-pay card users were determined during the enrollment period and the number of co-pay card redemptions was calculated during the follow-up period for each co-pay card user Powered by Adheris Health Source: Zitter Health Insights: Co-Pay Offset Monitor, Apr 2015

12 Pre-Benefit Primary Co-Pay Diabetes C O M M E R C I A L LY I N S U R E D PAT I E N T S ( F O R 3 0 D AY S U P P LY ) Patients using co-pay cards have almost a double in their co-pay per prescription when compared with patients who do not use co-pay cards. With Co-pay Card (n=35,908) Without Co-pay Card (n=62,157) $73 $95 $42 $40 $89 $41 $61 $36 $100 $44 $78 $39 $91 $48 $78 $40 $19 $16 BYDUREON (n=1,450/5,145) BYETTA (n=116/2,728) FARXIGA (n=4,164/5,060) INVOKANA (n=13,975/9,914) JANUVIA (n=7,697/21,963) JARDIANCE (n=859/319) TRADJENTA (n=1,543/4,393) TRULICITY (n=33/31) VICTOZA (n=6,071/12,604) January 2014 June 2014 Patients were enrolled in a 6-month ( January 1, 2-14 to June ) cohort and were followed for 6 months. Co-pay card users were determined during the enrollment period and the number of co-pay card redemptions was calculated during the follow-up period for each co-pay card user Powered by Adheris Health Source: Zitter Health Insights: Co-Pay Offset Monitor, Apr 2015

13 Where do savings cards fit in today? What do they actually do? Reduce patients out-of-pocket costs What influences a patients out-of-pocket costs today? Formulary status High deductible plan designs Multiple therapies What can happen when out-of-pocket costs are too high? Higher abandonment rate Lower adherence rate Greater therapeutic switching

14 Where do savings cards fit in today?

15 Designing a Savings Card Program What types of things should I be thinking about? 1. What patient needs are you trying to address? 2. What offer(s) might address that need? 3. What is the best channel mix? (point of care/sale, web, etc) 4. How will you determine whether the need was met? 5. What are your competitors doing? 15

16 What are you PATIENTS solving for? If access barriers are the problem, is improved access the solution? Do patients want a $0 card or reliable and affordable access Is your value proposition real or perceived? How do patients define access? Savings Cards Educational Materials SAVE NOW $0 Co-Pay BIN: PCN: Group: ID: OR Adherence Solutions Access Solutions Pull-through Solutions Reimbursement Support Benefit Verification

17 Are you providing VALUE or just [$0] cards? This chart shows: 1. $25 co-pay establishes 80% product use 2. $12 co-pay increases use to 97% Do Drs know the actual co-pay in advance? Drs want reliable and affordable access Price elasticity of demand Product for vasomotor symptoms Physician Responses Patient copay/out of pocket cost % of patients expected to be prescribed No coupon $ % With coupon $ % No coupon $ % With coupon $ % No coupon $ % With coupon $ % No coupon $ % With coupon $ % No coupon $ % With coupon $ % Source: Research conducted by Medical Marketing Economics, LLC

18 Understand the Relevant Challenges Patient Considerations How many different meds are patient s taking? What are the avg. co-pays for each? Lifecycle Considerations Are you a launch brand or a mature brand? What are your goals? Formulary Considerations How strong is your coverage? What s your average co-pay? Market Considerations How many other branded/generic products are there? What are your competitors doing?

19 Where do access challenges exist? Providers Office Providers Office Awareness Trial Usage Patients Pharmacies Abandonment Substitution Retention/Adherence Formularies Pharmacies Formularies Tier Status Co-Pay Deductibles

20 How patients needs differ by channel? Rep Delivered Pharmacy Source: PM360 Feb 2015/Chris Dowd PSKW/ Channel Selection: The Second Step to Successful Co-Pay Programs

21 Summary Healthcare industry is changing significantly The role of savings cards has evolved Worsening access restrictions for patients More holistic access solutions benefit patients Align channel strategies with patients needs

The Real Deal About Real-Time Benefits. Proven Savings with Up-to-the-Minute, Member-Specific Information Across Multiple Points of Care

The Real Deal About Real-Time Benefits. Proven Savings with Up-to-the-Minute, Member-Specific Information Across Multiple Points of Care The Real Deal About Real-Time Benefits Proven Savings with Up-to-the-Minute, Member-Specific Information Across Multiple Points of Care Cost is a key issue for plan members and a common barrier to medication

More information

PRESCRIPTION DRUG SPENDING IN THE U.S. HEALTH CARE SYSTEM: AN ACTUARIAL PERSPECTIVE

PRESCRIPTION DRUG SPENDING IN THE U.S. HEALTH CARE SYSTEM: AN ACTUARIAL PERSPECTIVE PRESCRIPTION DRUG SPENDING IN THE U.S. HEALTH CARE SYSTEM: AN ACTUARIAL PERSPECTIVE Moderator Audrey Halvorson, Vice Chairperson, Health Practice Council Presenters Karen Bender, Member, Prescription Drug

More information

Overcoming Barriers and Challenges in Reimbursement

Overcoming Barriers and Challenges in Reimbursement Overcoming Barriers and Challenges in Reimbursement Tonya Somers MS,RD,CDE IUHP Diabetes Centers Program Manager Liz Daily RN, BSN, CDE IUHP Diabetes Centers Program Coordinator Tonya Somers MS,RD,CDE

More information

Lindsey Imada, PharmD Candidate 2016 Midwestern University, Chicago College of Pharmacy

Lindsey Imada, PharmD Candidate 2016 Midwestern University, Chicago College of Pharmacy Lindsey Imada, PharmD Candidate 2016 Midwestern University, Chicago College of Pharmacy Under the Preceptorship of Dr. Craig Stern Pro Pharma Pharmaceutical Consultants, Inc. September 11, 2015 S OBJECTIVES

More information

Q Formulary Performance:

Q Formulary Performance: Insights Executive Briefing Issue 10, 2016 Q1 2016 Performance: Key Data to Consider as You Look Ahead to 2017 Increasingly our clients see proactive, dynamic formulary management as a necessary response

More information

WHITE PAPER How Consumer-Driven Healthcare Can Drive Down Costs for Payers

WHITE PAPER How Consumer-Driven Healthcare Can Drive Down Costs for Payers WHITE PAPER How Consumer-Driven Healthcare Can Drive Down Costs for Payers INTRODUCTION The United States healthcare system needs to confront one of its biggest issues head on the escalating cost of healthcare.

More information

Individual Business Prescription Drug Utilization Management Changes Frequently Asked Questions

Individual Business Prescription Drug Utilization Management Changes Frequently Asked Questions Individual Business Prescription Drug Utilization Management Changes Frequently Asked Questions Overview: Up to six prescription drug utilization/benefit management (UM) programs will be added to the individual

More information

The U.S. Healthcare System: How Pharmacy Benefit Managers Impact Prescription Drug Use. Presented by Daniel Tomaszewski Pharmd, PhD

The U.S. Healthcare System: How Pharmacy Benefit Managers Impact Prescription Drug Use. Presented by Daniel Tomaszewski Pharmd, PhD The U.S. Healthcare System: How Pharmacy Benefit Managers Impact Prescription Drug Use Presented by Daniel Tomaszewski Pharmd, PhD 1 Medical Vs. Pharmacy Coverage Medical Insurance Managed by an Insurance

More information

Pharmacy Benefit Managers Overview

Pharmacy Benefit Managers Overview Pharmacy Benefit Managers Overview A Presentation to the House Health Innovation Subcommittee Mary Alice Nye, Ph.D. Health and Human Services Staff Director, OPPAGA December 6, 2017 Pharmacy Benefit Managers

More information

Understanding Your Prescription Program. CCIU Employee Meeting September 7, 2016

Understanding Your Prescription Program. CCIU Employee Meeting September 7, 2016 Understanding Your Prescription Program CCIU Employee Meeting September 7, 2016 Welcome to FutureScripts! Founded in 2006 Philadelphia presence Strong ties to community and local businesses 68,000 pharmacies

More information

Disease Management and the Medicare Drug Benefit: Opportunities and Threats for the Pharmaceutical Industry

Disease Management and the Medicare Drug Benefit: Opportunities and Threats for the Pharmaceutical Industry Disease Management and the Medicare Drug Benefit: Opportunities and Threats for the Pharmaceutical Industry Jeffrey A. Bourret, M.S., R.Ph., FASHP Senior Director, Managed Markets Healthcare Systems Marketing

More information

FREQUENTLY ASKED QUESTIONS ABOUT THE CVS CAREMARK PRESCRIPTION DRUG PROGRAM

FREQUENTLY ASKED QUESTIONS ABOUT THE CVS CAREMARK PRESCRIPTION DRUG PROGRAM FREQUENTLY ASKED QUESTIONS ABOUT THE CVS CAREMARK PRESCRIPTION DRUG PROGRAM ABBVIE EMPLOYEES WANT TO KNOW 2018 Pharmacy Benefit Changes Q. What is the new prior authorization program? A. Certain brand

More information

Delivering Value for All Health Care Stakeholders. Larry Merlo President & Chief Executive Officer

Delivering Value for All Health Care Stakeholders. Larry Merlo President & Chief Executive Officer Delivering Value for All Health Care Stakeholders Larry Merlo President & Chief Executive Officer Agenda Our Value Proposition Has Never Been Stronger We See Compelling Opportunities in a Robust Health

More information

Pharmaceutical Management Community Plans 2018

Pharmaceutical Management Community Plans 2018 Pharmaceutical Management Community Plans 2018 Customer Service: (888) 327-0671 TTY: 711 Pharmacy Administration: (810) 244-1660 Introduction Pharmaceutical management promotes the use of the most clinically

More information

The State of New Mexico Group Benefits Plan Plan Year: January December 2018 Prescription Drug Program

The State of New Mexico Group Benefits Plan Plan Year: January December 2018 Prescription Drug Program The State of New Mexico Group Benefits Plan Plan Year: January December 2018 Prescription Drug Program 1 Who Is Express Scripts? Express Scripts administers your prescription drug benefit and you automatically

More information

Co-pay Accumulator Adjustment Programs

Co-pay Accumulator Adjustment Programs THE PHYSICIAN S PERSPECTIVE JUNE 2018 Co-pay Accumulator Adjustment Programs Madelaine A. Feldman, MD, FACR Not everyone can afford the medication they need. To make drugs more accessible, manufacturers

More information

Farm Bureau Select Rx 2017 Summary of Benefits January 1, December 31, 2017

Farm Bureau Select Rx 2017 Summary of Benefits January 1, December 31, 2017 P.O. Box 266380 Weston, FL 33326 Farm Bureau Select Rx 2017 Summary of Benefits January 1, 2017 - December 31, 2017 Thank you for your interest in Farm Bureau Select Rx, Our plan is offered by Members

More information

Pharmaceutical Management Commercial Plans

Pharmaceutical Management Commercial Plans Pharmaceutical Management Commercial Plans 2015 Toll Free Contact Number: (888) 327-0671 Medical Management: (810) 733-9711 Visit our website at: MclarenHealthPlan.org Introduction Pharmaceutical Management

More information

2015 PacificSource Medicare Part D Transition Process for contracts H3864 & H4754:

2015 PacificSource Medicare Part D Transition Process for contracts H3864 & H4754: 2015 PacificSource Medicare Part D Transition Process for contracts H3864 & H4754: Essentials Rx 6 (HMO), Essentials Rx 14 (HMO), Essentials Rx 15 (HMO), Essentials Rx 16 (HMO), Essentials Rx 19 (HMO),

More information

Value Three-Tier EFFECTIVE DATE: 01/01/2016 FORM #1779_03

Value Three-Tier EFFECTIVE DATE: 01/01/2016 FORM #1779_03 Value Three-Tier This brochure is a legal document that explains the prescription drug benefits provided by Harvard Pilgrim Health Care, Inc. (HPHC) to Members with plans that include outpatient pharmacy

More information

Primary Choice Plan Premium Three-Tier

Primary Choice Plan Premium Three-Tier Primary Choice Plan Premium Three-Tier This brochure is a legal document that explains the prescription drug benefits provided by the Group Insurance Commission (GIC) to their Members on a self-insured

More information

ACTIVELY MANAGED DRUG SOLUTIONS SPECIALTY DRUGS. Supporting employees and building sustainable drug plans...together

ACTIVELY MANAGED DRUG SOLUTIONS SPECIALTY DRUGS. Supporting employees and building sustainable drug plans...together ACTIVELY MANAGED DRUG SOLUTIONS SPECIALTY DRUGS Supporting employees and building sustainable drug plans...together Not available in the province of Quebec INTRODUCING THE SPECIALTY DRUG PROGRAM If you

More information

21 - Pharmacy Services

21 - Pharmacy Services 21 - Pharmacy Services The role of Health Plan of Nevada s (HPN) Pharmacy Services is to evaluate and determine the appropriateness of quality drug therapy while maintaining and improving therapeutic outcomes.

More information

The Declining Value of Payer Access: Defining and improving Rebate Efficiency in the current healthcare landscape

The Declining Value of Payer Access: Defining and improving Rebate Efficiency in the current healthcare landscape The Declining Value of Payer Access: Defining and improving Rebate Efficiency in the current healthcare landscape Lucas Greenwalt, Senior Principal Amundsen Consulting Prepared for: CBI Gross to Net Boot

More information

Your Prescription Drug Plan. Prescription Drug Plan CONTENTS PRESCRIPTION DRUG PLAN. (Performance Pipe Hourly Employees)

Your Prescription Drug Plan. Prescription Drug Plan CONTENTS PRESCRIPTION DRUG PLAN. (Performance Pipe Hourly Employees) (Performance Pipe Hourly Employees) Prescription Drug Plan CONTENTS Your Prescription Drug Plan...C-1 How the Plan Works...C-2 What s Covered...C-7 Precertification...C-7 Prescription Drug Management Programs...

More information

Farm Bureau Essential Rx 2018 Summary of Benefits January 1, December 31, 2018

Farm Bureau Essential Rx 2018 Summary of Benefits January 1, December 31, 2018 Farm Bureau Health Plans P.O. Box 266380 Weston, FL 33326 Farm Bureau Essential Rx 2018 Summary of Benefits January 1, 2018 - December 31, 2018 Thank you for your interest in Farm Bureau Essential Rx.

More information

Human Resources Development Compensation and Benefits Retiree Medical Insurance Plan (RMIP) Update

Human Resources Development Compensation and Benefits Retiree Medical Insurance Plan (RMIP) Update Human Resources Development Compensation and Benefits Retiree Medical Insurance Plan (RMIP) Update October 16, 2014 Agenda Introductions Medicare Enrollment Overview Medicare Enrollment Requirement Reimbursement

More information

Kroll Ontrack, LLC Prescription Drug Plan. Plan Document and Summary Plan Description

Kroll Ontrack, LLC Prescription Drug Plan. Plan Document and Summary Plan Description Kroll Ontrack, LLC Prescription Drug Plan Plan Document and Summary Plan Description Effective December 9, 2016 Kroll Ontrack, LLC reserves the right to amend the Kroll Ontrack, LLC Health & Welfare Plan

More information

FIND A DOCTOR Page 1 of 22

FIND A DOCTOR Page 1 of 22 www.hometownhealth.com FIND A DOCTOR Page 1 of 22 Type in Name of Doctor OR ADVANCED SEARCH You can filter your results by: Provider Last OR Group Name Provider Type City County Specialty Plan Zip Code

More information

Best Practice Recommendation for

Best Practice Recommendation for Best Practice Recommendation for Exchanging & Processing about Pharmacy Benefit Management Version 020915a Issue Date Version Explanation 10-20-2014 First Release 02-09-15 Clarify language under Health

More information

April 8, 2019 VIA Electronic Filing:

April 8, 2019 VIA Electronic Filing: April 8, 2019 VIA Electronic Filing: http://www.regulations.gov The Honorable Alex Azar Secretary Department of Health and Human Services 200 Independence Avenue SW, Room 600E Washington, D.C. 20201 Re:

More information

Prescription Drug Brochure

Prescription Drug Brochure Value Five-Tier Prescription Drug Brochure This brochure is a legal document that explains the prescription drug benefits provided by Harvard Pilgrim Health Care, Inc. (HPHC) to Members with plans that

More information

2019 Pre-Medicare Retiree Healthcare Open Enrollment

2019 Pre-Medicare Retiree Healthcare Open Enrollment 2019 Pre-Medicare Retiree Healthcare Open Enrollment CHANGES ONLY ENROLLMENT Submit Enrollment Changes Before November 21 You MUST complete and submit the enclosed enrollment form by November 21 if you

More information

White Paper: Formulary Development at Express Scripts

White Paper: Formulary Development at Express Scripts White Paper: Formulary Development at Express Scripts Express Scripts works with health-benefit plan sponsors and individual members of health plans to provide affordable access to clinically sound, high-quality

More information

Glossary of Terms. Adjudication: The way a health plan decides how much it will pay for certain expenses.

Glossary of Terms. Adjudication: The way a health plan decides how much it will pay for certain expenses. Page 1 Glossary of Terms Adjudication: The way a health plan decides how much it will pay for certain expenses. Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.

More information

Annual Notice of Changes

Annual Notice of Changes Annual Notice of Changes Utah Davis, Salt Lake, Utah and Weber Healthy Advantage Plus (HMO) (877) 644-0344, TTY/TDD 711 7 days a week, 8 a.m. 8 p.m. local time HealthyAdvantagePlus.org 2018 H5628_18_1127_0007_HPAE2

More information

(PDP) 2014 Summary of benefits for our Medicare prescription drug plans (Enhanced and Standard)

(PDP) 2014 Summary of benefits for our Medicare prescription drug plans (Enhanced and Standard) (PDP) 2014 Summary of benefits for our prescription drug plans (Enhanced and Standard) Contract S5540, Plans 004 and 002 January 1, 2014 December 31, 2014 U5073c, 8/13 Y0079_6249 CMS Accepted 09112013

More information

NeedyMeds

NeedyMeds NeedyMeds Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. REMEMBER - Send your

More information

Coverage Determinations, Appeals and Grievances

Coverage Determinations, Appeals and Grievances Coverage Determinations, Appeals and Grievances Filing a grievance (making a complaint) about your prescription coverage Asking for a coverage determination (coverage decision) 60-day formulary change

More information

YOUR GUIDE TO PRESCRIPTION DRUG BENEFITS

YOUR GUIDE TO PRESCRIPTION DRUG BENEFITS YOUR GUIDE TO PRESCRIPTION DRUG BENEFITS PHARMACY BENEFITS CAN BE CONFUSING, AND YOU PROBABLY HAVE LOTS OF QUESTIONS ABOUT USING YOUR DRUG PLAN. We re here to help. Because taking the right medicines when

More information

2019 Pre-Medicare Retiree Healthcare Open Enrollment

2019 Pre-Medicare Retiree Healthcare Open Enrollment 2019 Pre-Medicare Retiree Healthcare Open Enrollment CHANGES ONLY ENROLLMENT Submit Enrollment Changes Before November 21 You MUST complete and submit the enclosed enrollment form by November 21 if you

More information

Prescription Medication Schedule of Benefits

Prescription Medication Schedule of Benefits Prescription Medication Schedule of Benefits Rx Member Cost-Sharing: $15/$35/$70/$70 When you go to a pharmacy that participates in the UPMC Health Plan pharmacy network, you will be able to receive coverage

More information

Your. Multi-tiered. Prescription Drug Benefit Program. bcnepa.com

Your. Multi-tiered. Prescription Drug Benefit Program. bcnepa.com Your Multi-tiered Prescription Drug Benefit Program bcnepa.com What you need to know about your multi-tiered prescription drug program A formulary is our list of covered drugs and supplies organized by

More information

Arkansas State University System Prescription Drug Program

Arkansas State University System Prescription Drug Program Arkansas State University System Prescription Drug Program The Arkansas State University (ASU) prescription drug program involves a partnership with the University of Arkansas for Medical Sciences (UAMS)

More information

December 15, Committee on Energy and Commerce United States House of Representatives 2125 Rayburn House Office Building Washington, DC 20515

December 15, Committee on Energy and Commerce United States House of Representatives 2125 Rayburn House Office Building Washington, DC 20515 December 15, 2014 The Honorable Fred Upton Chairman The Honorable Diana DeGette Representative Committee on Energy and Commerce United States House of Representatives 2125 Rayburn House Office Building

More information

Toolkit Overview. Maximize Your Pharmacy Benefits

Toolkit Overview. Maximize Your Pharmacy Benefits Toolkit Overview Research shows that the vast majority of Medicare beneficiaries are not taking full advantage of their pharmacy coverage, resulting in poor medication adherence that can have a significant

More information

Prescription Drug Schedule of Benefits

Prescription Drug Schedule of Benefits Prescription Drug Schedule of Benefits Rx Member Cost-Sharing: $5/$15/$35/$35 When you go to a pharmacy that participates in the UPMC Health Plan pharmacy network, you will be able to receive coverage

More information

Manage your Prescriptions Online Through the Express Scripts Pharmacy

Manage your Prescriptions Online Through the Express Scripts Pharmacy Manage your Prescriptions Online Through the Express Scripts Pharmacy www.express-scripts.com Customer service specialists are also available 24 hours a day/7 days a week at 1-800-711-0917. Get a 90-day

More information

ECONOMIC PRINCIPLES IMPACTING MANAGED CARE PHARMACY. Adrian Washington PharmD., MBA Vice President of Client Management United Healthcare OptumRx

ECONOMIC PRINCIPLES IMPACTING MANAGED CARE PHARMACY. Adrian Washington PharmD., MBA Vice President of Client Management United Healthcare OptumRx ECONOMIC PRINCIPLES IMPACTING MANAGED CARE PHARMACY Adrian Washington PharmD., MBA Vice President of Client Management United Healthcare OptumRx As vice president, Adrian is responsible for strategic planning

More information

SPD Prescription Drugs Plan

SPD Prescription Drugs Plan Prescription Drugs Plan 08/01/2017 3-1 Your Prescription Drug Benefits The prescription drug benefit available to you is based on the medical plan in which you are enrolled. Regardless of the benefit design

More information

Important Prescription Benefit Information

Important Prescription Benefit Information Important Prescription Benefit Information Prepared Exclusively for: Mary Lanning Memorial Hospital medtrakrx.com Welcome to MedTrakRx Dear Member: This booklet contains important information about your

More information

Prescription Medication Rider

Prescription Medication Rider Prescription Medication Rider Rx Member Cost-Sharing: $16/$40/$80/$90 According to this prescription medication program, you may receive coverage for prescription medications in the amounts specified in

More information

Pharmacy Savings Card Frequently Asked Questions

Pharmacy Savings Card Frequently Asked Questions Pharmacy Savings Card Frequently Asked Questions How does the FacesRx Card work? When at the Pharmacy give your FacesRx Card to the Pharmacist. When the FacesRx Card information (BIN, PCN) is entered into

More information

NeedyMeds

NeedyMeds NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.

More information

summary of benefits Blue Shield of California Medicare Rx Plan (PDP)

summary of benefits Blue Shield of California Medicare Rx Plan (PDP) summary of benefits Blue Shield of California Medicare Rx Plan (PDP) An employer-sponsored Medicare Prescription Drug Plan for City and County of San Francisco retirees, spouses and eligible dependents

More information

Prescription Drug Rider

Prescription Drug Rider Prescription Drug Rider Rx Member Cost-Sharing: $10/$25/$40/$40 According to this prescription drug program, you may receive coverage for prescription drugs in the amounts specified in your rider when

More information

PRESCRIPTION DRUG PLANS. What is a PDP?

PRESCRIPTION DRUG PLANS. What is a PDP? PRESCRIPTION DRUG PLANS What is a PDP? PDP Since Original Medicare does not have prescription drug coverage built into it, Medicare beneficiaries must enroll into a plan that offers that coverage. Beneficiaries

More information

Real-Time Benefit Check (RTBC) Solution Assessment. Requirements for selecting the most valuable RTBC solution for your health system

Real-Time Benefit Check (RTBC) Solution Assessment. Requirements for selecting the most valuable RTBC solution for your health system Real-Time Benefit Check (RTBC) Solution Assessment Requirements for selecting the most valuable RTBC solution for your health system Prescription cost is the primary predictor of medication abandonment.

More information

Clinical Policy: Brand Name Override Reference Number: CP.PMN.22 Effective Date: Last Review Date: 02.18

Clinical Policy: Brand Name Override Reference Number: CP.PMN.22 Effective Date: Last Review Date: 02.18 Clinical Policy: Reference Number: CP.PMN.22 Effective Date: 09.01.06 Last Review Date: 02.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important regulatory

More information

SelectHealth Prescriptions

SelectHealth Prescriptions SelectHealth Prescriptions pharmacy benefit management program SM SelectHealth Prescriptions is a full-service Pharmacy Benefit Manager (PBM) that offers transparent pricing, clinically based programs,

More information

Prescription Medication Rider

Prescription Medication Rider Prescription Medication Rider Rx Member Cost-Sharing: $16/$40/$80/$90 HealthyU HIA/HRA According to this prescription medication program, you may receive coverage for prescription medications in the amounts

More information

Pharmacy Trend Management

Pharmacy Trend Management Pharmacy Trend Management Strategies for Maximizing the Value of Your Pharmacy Spend Presenter's Name Presentation Date May 1, 2008 Today s speakers Bridget Eber, Pharm.D. Principal and National Pharmacy

More information

Excellus BlueCross BlueShield Participating Provider Manual. 5.0 Pharmacy Management

Excellus BlueCross BlueShield Participating Provider Manual. 5.0 Pharmacy Management Excellus BlueCross BlueShield Participating Provider Manual 5.0 Pharmacy Management 5.1 Pharmacy Benefits The Health Plan is committed to effectively managing prescription drug benefit costs and providing

More information

Introduction to the US Health Care System. What the Business Development Professional Should Know

Introduction to the US Health Care System. What the Business Development Professional Should Know Introduction to the US Health Care System What the Business Development Professional Should Know November 2006 1 Understanding of the US Health Care System Evolution of the US health care system to its

More information

Inside: Critical information about your company s prescription drug benefit.

Inside: Critical information about your company s prescription drug benefit. Inside: Critical information about your company s prescription drug benefit. Questions Company Benefits Managers Must Ask Their PBM It pays to make an informed decision harmacy Benefit Managers, often

More information

Understanding Pharmacy Benefit Management Services

Understanding Pharmacy Benefit Management Services Understanding Pharmacy Benefit Management Services Peter Cullen VP, Business Development and Strategic Initiatives March 12, 2014 Innovation Session Overview and Learning Objectives Session Overview: Provide

More information

Contents General Information General Information

Contents General Information General Information Contents General Information... 1 Preferred Drug List... 2 Pharmacies... 3 Prescriptions... 4 Generic and Preferred Drugs... 5 Express Scripts Website and Mobile App... 5 Specialty Medicines... 5 Prior

More information

What to Expect for Pharmacy Benefits and Drug Cost Trends for 2018 & 2019

What to Expect for Pharmacy Benefits and Drug Cost Trends for 2018 & 2019 What to Expect for Pharmacy Benefits and Drug Cost Trends for 2018 & 2019 Mid-Sized Retirement and Healthcare Plan Management Conference 2018. Innovative Rx Strategies, LLC. All rights reserved. The Ever

More information

Public and Private Payer Responses to Pharmaceutical Pricing in the United States

Public and Private Payer Responses to Pharmaceutical Pricing in the United States Public and Private Payer Responses to Pharmaceutical Pricing in the United States James C. Robinson Leonard D. Schaeffer Professor of Health Economics Director, Berkeley Center for Health Technology University

More information

Harvard Pilgrim s Stride (HMO) Medicare Advantage Plan

Harvard Pilgrim s Stride (HMO) Medicare Advantage Plan HP19ANOCNHBASIC 2019 Harvard Pilgrim s Stride (HMO) Medicare Advantage Plan Annual Notice of Changes Basic Rx New Hampshire Y0098_19020_M Stride SM Basic Rx (HMO) offered by Harvard Pilgrim Health Care

More information

Insurance & Medication Access

Insurance & Medication Access Insurance & Medication Access Ontario Rheumatology Association 12th Annual Meeting JW Marriott The Rosseau Muskoka May 25, 2013 Suzanne Lepage, Private Health Plan Strategist Learning Objectives Understand

More information

Chapter 17: Pharmacy and Drug Formulary

Chapter 17: Pharmacy and Drug Formulary Chapter 17: Pharmacy and Drug Formulary Introduction Health Choice Insurance Co. (Health Choice) is pleased to provide the Health Choice Formulary, which is available on line at www.healthchoiceessential.com/members/rxdrugs.

More information

Aetna Funding Advantage National Plans Effective 04/01/2018

Aetna Funding Advantage National Plans Effective 04/01/2018 Preferred / Nonpreferred Preferred and and Brand Nonpreferred Specialty 100/50 500D $0/$0 $6,000/$12,000 $35 copay/$75 copay $500 copay $100 copay None $3 copay /$10 copay $45 copay/$70 copay $20 copay;

More information

Prescription Drug Plan Update

Prescription Drug Plan Update Prescription Drug Plan Update Kenyon College May 24, 2018 1 Plan Design Changes effective July 1, 2018 Basic Plan Current Basic Plan 7/1/2018 Premium Plan Current Premium Plan 7/1/2018 Annual Deductible

More information

Managed Care Pharmacy Commercial Perspective

Managed Care Pharmacy Commercial Perspective Managed Care Pharmacy Commercial Perspective Lida Etemad, PharmD, MS VP, Pharmacy Management Strategies UHC E&I Overview I. My background II. Process for PDL Review III. Management Strategies IV. Medical

More information

CDHP Special Administration

CDHP Special Administration CDHP Special Administration Your prescription coverage under the Consumer Driven Health Plan (CDHP) is subject to special administration from the PPO plans and this page will explain those differences:

More information

Prime therapeutics medicare part d preferred drug list 2017

Prime therapeutics medicare part d preferred drug list 2017 Prime therapeutics medicare part d preferred drug list 2017 Apr 28, 2018. Explore part D, part B formulary medication and non-formulary drug list.. Prior Authorization and Step Therapy criteria at Prime

More information

NeedyMeds

NeedyMeds NeedyMeds Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. REMEMBER - Send your

More information

SecurityBlue HMO. Link to Specific Guidance Regarding Exceptions and Appeals

SecurityBlue HMO. Link to Specific Guidance Regarding Exceptions and Appeals SecurityBlue HMO Conditions and Limitations Potential for Contract Termination Disenrollment Rights and Instructions Exceptions, Prior Authorization, Appeals and Grievances Out-of-Network Coverage Quality

More information

Share a Clear View. El Paso Children's Hospital. Printed on:

Share a Clear View. El Paso Children's Hospital. Printed on: Share a Clear View El Paso Children's Hospital Printed on: Share a Clear View NAVITUS CUSTOMER CARE HOURS: 24 Hours a Day 7 Days a Week 855-673-6504 (toll-free) TTY (toll-free) 711 MAILING ADDRESS: Navitus

More information

Prescription Drug Coverage

Prescription Drug Coverage The Company s medical plans automatically include coverage for prescription drugs which is administered by Envision Pharmaceutical Services, Inc. (Envision Rx) for prescriptions filled at retail pharmacies

More information

How Does a CDHP Work with an HSA

How Does a CDHP Work with an HSA How Does a CDHP Work with an HSA 1 What is an HSA? A Health Savings Account (HSA) is a tax-advantaged checking account that works in conjunction with your Consumer Driven Health Plan (CDHP). Allows you

More information

National Grid Retiree Club Meeting Long Island. October 2, 2017

National Grid Retiree Club Meeting Long Island. October 2, 2017 National Grid Retiree Club Meeting Long Island October 2, 2017 18 Agenda Definitions 2018 Highlights for Management Retirees & Dependents Under Age 65 2018 Highlights for Local 1049 Retirees & Dependents

More information

Princeton University Prescription Drug Plan Summary Plan Description

Princeton University Prescription Drug Plan Summary Plan Description Princeton University Prescription Drug Plan Summary Plan Description Princeton University Prescription Drug Plan Summary Plan Description January 2018 Introduction... 1 How the Plan Works... 2 Formulary...

More information

Innovative Strategies for Managing the Rising Cost of Specialty Drugs

Innovative Strategies for Managing the Rising Cost of Specialty Drugs Innovative Strategies for Managing the Rising Cost of Specialty Drugs Mid-sized Retirement and Healthcare Plan Management Conference Chicago, IL June 5, 2013 Managing the Rising Cost of Specialty Drugs

More information

2010 Summary of Benefits S5601

2010 Summary of Benefits S5601 P.O. Box 280200, Nashville, TN 37228 Contact SilverScript Insurance Company for more information about our plans NOTE: Please contact us if you have questions or concerns about our plans. representatives

More information

The Management of Specialty Drugs: Opportunities and Challenges

The Management of Specialty Drugs: Opportunities and Challenges The Management of Specialty Drugs: Opportunities and Challenges Scott Woods Senior Director, Policy PCMA Innovations X April 5, 2016 Specialty Drugs to be Half of Spend by 2018 Forecast PMPM Net Drug

More information

BMR Prescription Drug Plan

BMR Prescription Drug Plan United Workers Health Fund BMR Prescription Drug Plan Welcome Kit Dear United Workers Health Fund Member: Welcome to Broadreach Medical Resources, Inc. (BMR), the program administrator for the United Workers

More information

Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.

Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?

More information

Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.

Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?

More information

benefits know your 2018 City of Jacksonville Benefits Guide Do you have questions about your medical or prescription drug coverage?

benefits know your 2018 City of Jacksonville Benefits Guide Do you have questions about your medical or prescription drug coverage? 2018 B E N E F I T S G U I D E We are pleased to announce that we will be renewing our medical and pharmacy benefit plans with Florida Blue for 2018. This Benefit Guide provides important information and

More information

2011 Summary of Benefits

2011 Summary of Benefits 2011 Summary of Benefits (PDP) and January 1, 2011 December 31, 2011 BlueCross BlueShield of South Carolina contracts with the federal government. Contract # s5953 (PDP) s5953_pdp2011sb cms approved 08312010

More information

Prescription Drug Services

Prescription Drug Services Prescription Drug Services Table of Contents Prescription Drug Services... 1 Formulary... 1 Copayments for Drugs... 2 Retail Pharmacy Benefit... 2 Mail Order Pharmacy Benefit... 3 Nonformulary and Prior

More information

PRESCRIPTION MEDICINE PRICING OUR PRINCIPLES AND PERSPECTIVES

PRESCRIPTION MEDICINE PRICING OUR PRINCIPLES AND PERSPECTIVES PRESCRIPTION MEDICINE PRICING OUR PRINCIPLES AND PERSPECTIVES We at Sanofi work passionately, every day, to understand and solve health care needs of people across the world. We are dedicated to therapeutic

More information

TouchScript Medication Management System. Financial Impact Analysis on Pharmacy Risk Pools

TouchScript Medication Management System. Financial Impact Analysis on Pharmacy Risk Pools TouchScript Medication Management System Financial Impact Analysis on Pharmacy Risk Pools October 2000 Table of Contents Introduction 3 Executive Summary.. 4-5 Quantitative Analysis 6-10 TouchScript Impact

More information

SBCFF Modified Rx 10/30/45 Prescription Drug Benefits

SBCFF Modified Rx 10/30/45 Prescription Drug Benefits Rx Benefits SBCFF Modified Rx 10/30/45 Prescription Drug Benefits This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently

More information

Annual Notice of Changes for 2018

Annual Notice of Changes for 2018 Providence Medicare Align Group Plan + RX (HMO) offered by Providence Health Assurance Annual Notice of Changes for 2018 You are currently enrolled as a member of Providence Medicare Align Group Plan +

More information

State Health Plan 101

State Health Plan 101 State Health Plan 101 2017 Pharmacy Benefit Changes November 2016 Agenda New Pharmacy Benefit Manager Pharmacy Benefits Overview and Changes Q&A session 2 New Pharmacy Benefit Manager As of Jan. 1, 2017,

More information

Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.

Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?

More information

Co-pay Card Program Monitoring and Optimization November 2014

Co-pay Card Program Monitoring and Optimization November 2014 Primary/Final Payer Analysis Co-pay Card Program Monitoring and Optimization November 2014 Symphony Health Solutions offers an array of Managed Markets Studies CONSULTING/ANALYTICAL STUDIES Managed Markets

More information